E-BULLETIN
Edition 13
April 2016
UNINTENTIONAL (ACCIDENTAL)
HOSPITAL-TREATED INJURY
VICTORIA
2014/15
Tharanga Fernando
Angela Clapperton
Janneke Berecki-Gisolf
1
Suggested citation
VISU: Fernando T, Clapperton A and Berecki-Gisolf J (2016). Unintentional (accidental) hospitaltreated injury Victoria, 2014/15. E-bulletin Edition 13. Victorian Injury Surveillance Unit. Monash
University Accident Research Centre.
2
E-bulletin 13 – VISU April 2016
Contents
Summary results ............................................................................................................................... 4
All ages...................................................................................................................................... 4
Children (0-14 years) ................................................................................................................. 4
Adolescents and young adults (15-24 years) ............................................................................. 5
Adults (25-64 years) .................................................................................................................. 5
Older adults (65 years and older) ............................................................................................... 6
Introduction ........................................................................................................................................................ 8
Method ................................................................................................................................................................ 8
Data Sources ............................................................................................................................. 8
Case Selection Criteria ............................................................................................................... 8
Rates and trends analysis .......................................................................................................... 8
All ages ............................................................................................................................................................. 10
Children (0-14 years)...................................................................................................................................... 20
Adolescents and young adults (15-24 years) ............................................................................................. 25
Adults (25-64 years) ....................................................................................................................................... 30
Older adults (65 years and older) ................................................................................................................. 35
Appendix 1 ....................................................................................................................................................... 40
Appendix 2 ....................................................................................................................................................... 42
Abbreviations
AIHW
Australian Institute of Health and Welfare
DHHS
Department of Health and Human Services
ED
Emergency Department
VAED
Victorian Admitted Episodes Dataset
VEMD
Victorian Emergency Minimum Dataset
3
Summary results
E-bulletin 13 – VISU April 2016
Unintentional (accidental) hospital-treated injury in Victoria
2014/15
This is the thirteenth in a series of regular E-bulletins that provide an overview of the injury profile for
Victoria. This edition provides an overview of unintentional (‘accidental’) hospital-treated injury in
2014/15 utilising two injury surveillance datasets that separately record hospital admissions and
Emergency Department (ED) presentations for injury.
The case selection and format of this edition differs from the ones prior. Three major changes have
been made to the injury case selection strategy. They are: (1) adjusting the pre 2012/13 hospital
admissions data to correct for the hospital admission policy change in 2012/13; (2) selection of
hospital admission injury cases restricted to those with a “community injury” in the principal
diagnosis code and (3) subsequent admissions post presentation to the ED are now included in the
ED presentations results.
Summary results
There were 96,141 injury cases admitted to Victorian hospitals in 2014/15 of which 90.7% were
unintentional. At least 314,961 injury cases presented to Victorian EDs, 80.2% of which were
unintentional.
All ages

The age-standardised annual rate of injury admissions increased significantly by 3.30% per year
over the 11-year period 2004/05 to 2014/15.

The age-standardised annual rate of injury ED presentations increased significantly by 1.20%
per year over the 11-year period 2004/05 to 2014/15.

Males were overrepresented, accounting for 55% of admissions and 58% of ED presentations.

Falls were the leading cause of injury among admissions and ED presentations, accounting for
47% of admissions and 38% of ED presentations.

The home was the most common setting for injury among admissions and ED presentations:
26% of hospital admissions and 40% of ED presentations.

Fracture to upper limb was the most common injury for both admissions and ED presentations
(19% and 12%, respectively).
Children (0-14 years)

13,185 children were admitted to Victorian hospitals and at least 90,726 presented to Victorian
EDs for unintentional injury during 2014/15.

The age-standardised annual rate of injury admissions among children aged 0-14 years
increased significantly by 2.50% per year over the 11-year period 2004/05 to 2014/15.

The age-standardised annual rate of injury ED presentations among children aged 0-14 years
increased significantly by 2.12% per year over the 11-year period 2004/05 to 2014/15.
4
Summary results
E-bulletin 13 – VISU April 2016

Males were overrepresented, accounting for 61% of admissions and 57% of ED presentations.

Falls were the leading cause of both injury admissions (48%) and ED presentations (46%).

Twenty-four percent of hospital admissions and almost half of ED presentations (46%) were for
injuries that occurred in the home. Children were also commonly injured in schools and other
public buildings (12% of admissions and 13% of ED presentations) and sports and athletics
areas (10% each of both admissions and ED presentations).

Fracture to upper limb was the most common injury for both the admissions and ED
presentations among children (31% and 17%, respectively).
Adolescents and young adults (15-24 years)

12,316 adolescents and young adults were admitted to Victorian hospitals and at least 55,235
presented to Victorian EDs for unintentional injury during 2014/15.

The age-standardised annual rate of injury admissions among adolescents and young adults
increased significantly by 2.77% per year over the 11-year period 2004/05 to 2014/15.

The age-standardised annual rate of injury ED presentations among adolescents and young
adults remained fairly stable over the 11-year period 2004/05 to 2014/15.

Males were overrepresented, accounting for 74% of admissions and 67% of ED presentations.

Transport was the leading cause of injury admissions (23%) followed by falls (19%) and
hit/struck/crush (16%). Among ED presentations, falls was the leading cause of injury (27%)
followed by hit/struck/crush (26%) and transport (10%). Cutting & piercing injuries accounted for
around 10% of both admissions and ED presentations.

Sports and athletics areas (22%) and the road, street and highway (14%) were the most
common settings for adolescent and young adult injuries resulting in hospital admission
whereas the home (24%) and sports and athletics areas (21%) were the leading settings for
injuries resulting in ED presentation.

Fracture to upper limb was the most common injury among adolescent and young adult hospital
admissions (20%) while dislocation, sprain & strain to lower limb was the more common reason
for ED presentations (15%).
Adults (25-64 years)

37,846 adults were admitted to Victorian hospitals while at least 125,221 presented to Victorian
EDs for unintentional injury during 2014/15.

The age-standardised annual rate of injury admissions among adults increased significantly by
3.69% per year over the 11-year period 2004/05 to 2014/15.

The age-standardised annual rate of injury ED presentations among adults remained fairly over
the 11-year period 2004/05 to 2014/15.

Males were overrepresented, accounting for 63% of admissions and 61% of ED presentations.
5
Summary results
E-bulletin 13 – VISU April 2016

The leading cause of adult hospital-treated injury was falls: 28% of hospital admissions and ED
presentations. Other major causes were hit/struck/crush (10% of admissions and 17% of ED
presentations), cutting and piercing (11% of admissions and 12% of ED presentations) and
transport (20% of admissions and 9% of ED presentations).

Seventeen percent of hospital admissions and 37% of ED presentations were for injuries that
occurred in the home. Other major settings for injury were: working for income (13% of
admissions and 15% of ED presentations) and road/street/highway (14% of admissions and
10% of ED presentations).

Fracture to upper limb was the most common injury among adult hospital admissions (18%)
while dislocation, sprain & strain to lower limb and open wound to upper limb were the more
common reasons for ED presentations (10% each).
Older adults (65 years and older)

32,794 older adults were admitted to Victorian hospitals and at least 43,779 presented to
Victorian EDs for unintentional injury during 2014/15.

The age-standardised annual rate of injury admissions among older adults increased
significantly by 3.54% per year over the 11-year period 2004/05 to 2014/15.

The age-standardised annual rate of injury ED presentations among older adults increased
significantly by 1.68% per year over the 11-year period 2004/05 to 2014/15.

Females were overrepresented, accounting for 65% of admissions and 58% of ED
presentations.

Falls accounted for more than three-quarters of hospital admissions (77%) and more than half of
ED presentations (62%) among older adults.

Forty-three percent of hospital admissions and more than half of ED presentations (54%) were
for injuries that occurred in the home. Other common settings for injuries were residential
institutions (17% of admissions and 8% of ED presentations) and the road/street/highway (8% of
both admissions and ED presentations).

Fracture to lower limb was the most common injury among older adult hospital admissions
(22%) and among ED presentations (13%).
6
E-bulletin 13 – VISU April 2016
Summary results
Table 1: Summary results for 2014/15
All
Child
(0-14 years)
Adolescent
(15-24 years)
Adults
(25-64 years)
Older adults
(65+ years)
Admissions
n
96,141
13,185
12,316
37,846
32,794
Rate/100,000
1,633.5
1,224.1
1,576.3
1,201.7
3,735.6
Age standardised
rate/100,000
1,563.9
1,224.3
1,577.0
1,192.5
3,590.8
Rate change (% per year)
3.3
2.5
2.8
3.7
3.5
% males
54.7
61.2
73.6
63.1
35.4
Falls
(46.5)
Home
(25.6)
Fracture
upper limb
(18.7)
Falls
(48.2)
Home
(23.8)
Fracture upper
limb
(30.6)
Transport
(22.5)
Sports
(22.0)
Fracture upper
limb
(20.3)
Falls
(28.4)
Home
(17.3)
Fracture upper
limb
(18.4)
Falls
(77.3)
Home
(42.7)
Fracture lower
limb
(22.1)
n/a
1.1
3.0
12.8
83.1
Leading cause (%)
Most common setting (%)
Most common injury (%)
% of all serious injury cases
(row %)
ED presentations
n
314,961
90,726
55,235
125,221
43,779
Rate/100,000
5,351.3
8,422.8
7,069.4
3,976.1
4,987.0
Age standardised
rate/100,000
5,411.4
8,432.4
7,109.6
3,985.7
4,882.2
1.2
2.1
stable
stable
1.7
Rate change (% per year)
% males
Leading cause (%)
Most common setting (%)
Most common injury (%)
58.2
57.4
67.0
60.6
41.8
Falls
(37.7)
Home
(39.7)
Falls
(46.2)
Home
(45.9)
Falls
(27.0)
Home
(23.6)
Falls
(61.6)
Home
(54.3)
Fracture to
upper limb
(11.8)
Fracture upper
limb
(17.4)
Dislocation,
sprain & strain
to lower limb
(14.7)
Falls
(28.0)
Home
(37.3)
Dislocation,
sprain & strain
to lower limb
& Open wound
to upper limb
(10.3)
Fracture lower
limb
(13.4)
Notes:
1) Rate change (% per year) refers to the average change in age standardised rate over 11 years: 2004/5 to 2014/15.
2) Red highlighted cells represent an increase and yellow represents no significant change.
3) A serious injury is defined as one with an ICD based Injury Severity Score (ICISS) of less than or equal to 0.941 (see
Box 1 in Appendix 1 for details).
4) Percentage of serious injuries is based solely on hospital admissions as this measure is not available in the ED
presentation data.
7
Introduction and methods
E-bulletin 13 – VISU April 2016
Introduction
This E-bulletin provides information on unintentional hospital-treated injury in 2014/15. There were
105,959 injury hospital admissions in Victoria in 2014/15 (excluding complications of surgical and
medical care, adverse effects of drugs in therapeutic use and late effects of injury), 90.7% of which
were unintentional (n=96,141). The remaining injury cases were either intentional i.e. self-harm or
assault (7.7%, n=8,110) or of other or undetermined intent (1.6%, n=1,708). In this same year, there
were 392,512 injury cases presenting to Victorian hospital EDs, 80.2% of which were unintentional
(n=314,961), 4% were intentional (self-harm or assault) (n=15,576) and 15.8% were of other or
undetermined intent (n=61,975).
Method
Data sources
Hospital admissions data were extracted from the Victorian Admitted Episodes Dataset (VAED) and
ED presentations data from the Victorian Emergency Minimum Dataset (VEMD). The VAED records
all hospital admissions in public and private hospitals in the state of Victoria and the VEMD records
all presentations to Victorian public hospitals with 24-hour emergency departments1.
Case selection criteria
Cases were selected if the admission (VAED) or presentation (VEMD) date occurred in the financial
year 2014/15, and if the injury was unintentional (VAED: external cause code in the range V00-X59,
VEMD: human intent=1). Hospital admission cases were selected only if the first occurring
diagnosis code was a community injury (see Box 2 in Appendix 2) and the case was not a statistical
separation from another unit within the same hospital or an inward transfer from another hospital.
ED presentation case selection was restricted to incident cases: return visits and pre-arranged visits
were excluded.
In order to minimise the influence of the hospital admission policy change in 2012/13 on the time
trends in admissions, cases that spent the entire episode in the ED have been removed from the
VAED (see Box 3 in Appendix 2).
For ease of comparison VEMD causes, where possible, were recoded to match VAED cause
groups.
The age groups (0-14, 15-24, 25-64, 65+) have been selected to match those in the National Injury
Prevention and Safety Promotion Plan: 2004 - 2014 (NIPSPP Plan).
See Appendix 2 for a detailed explanation of the case selection criteria.
Rates and trends analysis
Rates per 100,000 population have been calculated for the 11-year period 2004/05 to 2014/15 for
the VAED and the VEMD2. The denominators used for calculating rates from were December
population estimates from the Australian Bureau of Statistics. Age standardisation of rates was
carried out using 5-year age groups and the direct method. The standard population used was the
Victorian resident population at 30 June, 2001.
1
Currently 39 hospitals contribute to the VEMD (Bass Coast Regional Health was added to the collection in July 2011)
The selection of the particular time period 2004/05-2014/15 is because the number of hospitals contributing to the VEMD has largely
been consistent since 2004/05.
2
8
Introduction and methods
E-bulletin 13 – VISU April 2016
Time trends in the rate of admissions/ED presentations were modelled using Poisson models, as
the annual number of events as a function of time in years (continuous), age group and gender, with
the log of the annual Victorian residential population as offset.
Time trend results are presented as the modelled % change in rate per year, calculated as:
where α is the parameter estimate of year, in the Poisson model. A trend was considered to be
statistically significant if the p-value of the slope of the regression model was less than 0.05.The
analyses were conducted using the PROC GENMOD procedure in SAS V9.4.
For further discussion of data sources and issues refer to Appendix 2 (page 39).
Note:
The terms “admissions” and “presentations” in succeeding sections of this report refers to “injury
admissions” and “injury presentations”; results are limited to the State of Victoria.
9
E-bulletin 13 – VISU April 2016
All ages
All ages
Table 2 provides an overview of unintentional hospital-treated injury in Victoria during 2014/15.
Overall, there were 96,141 admissions and 255,031 ED presentations.

The hospital admission rate was highest in older adults (3,735.6 per 100,000) and lowest in
adults (1,201.7 per 100,000).
The ED presentation rate was highest in children (8,422.8 per 100,000) and lowest in adults
(3,976.1 per 100,000).

Table 2: Hospital treated injury frequency, age-specific and standardised rates by broad age group,
Victoria 2014/15.
Age group
Hospital admissions
Age
Rate/ standardised
100,000
rate per
100,000
1,224.1
1,224.3
1,576.3
1,577.0
1,201.7
1,192.5
3,735.6
3,590.8
1,633.5
1,563.9
n
Children 0-14 years
Adolescents and young adults 15-24 years
Adults 25-64 years
Older adults 65+ years
All
13,185
12,316
37,846
32,794
96,141
ED presentations
(includes subsequent admissions)
Age
Rate/ standardised
n
100,000
rate per
100,000
90,726
8,422.8
8,432.4
55,235
7,069.4
7,109.6
125,221
3,976.1
3,985.7
43,779
4,987.0
4,882.2
314,961
5,351.3
5,411.4
Figure 1 shows hospital admission injury rates by age and gender for Victoria in 2014/15. Agespecific hospital admitted injury rates rose after childhood, were higher in adolescents and young
adults than in adults and peaked in older adults. The overall male age-specific hospital admitted
injury rate was higher than the female rate in all 5-year age groups to age 65 years.
Figure 1:
Age-specific hospital admitted injury rates by age group and gender, Victoria 2014/15
18,000
16,000
14,000
Rate per 100,000
12,000
10,000
8,000
6,000
4,000
2,000
0
0-4
5–9
10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85-89 90-94
MALE
1390
1352
1655
FEMALE
1065
1031
816
857
850
727
674
708
753
PERSONS 1232
1195
1246
1585
1569
1286
1113
1070
1141
2276
2255
1847
1555
1435
1544
1474
95+
TOTAL
1504
1408
1445
1526
1795
2590
4335
7126 10329 13902 1808
810
983
1145
1379
1777
2407
3732
6112 10220 13801 16385 1462
1137
1239
1274
1411
1655
2111
3195
5339
9000 12664 15736 1633
Age group
10
E-bulletin 13 – VISU April 2016
All ages
Figure 2 shows ED presentation injury rates by age and gender for Victoria in 2014/15. Age-specific
injury ED presentation rates were high among children (0-9 years) and highest among older children
(10-14 years) and then decreased throughout the adolescent and adult age groups until age 65
when rates increased. The overall male age-specific injury hospital ED presentations rate was
higher than the female rate in all 5-year age groups up to age 70 years.
Figure 2:
Age-specific injury ED presentation rates by age group and gender, Victoria 2014/15
16,000
14,000
12,000
Rate per 100,000
10,000
8,000
6,000
4,000
2,000
0
0-4
5–9
10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 80–84 85-89 90-94
95+
TOTAL
MALE
9494
8085 10769 9995
8613
6812
5494
5113
5027
4479
4124
3646
3509
3443
3576
4293
5886
8406
FEMALE
7793
6874
7434
5114
4495
3596
3004
2978
2954
2856
3060
3079
3152
3372
3793
4954
6681
9474 12071 14371 4424
PERSONS 8667
7496
9143
7619
6601
5200
4244
4039
3971
3654
3582
3356
3326
3406
3688
4643
6335
9053 11248 14105 5351
9557 13355 6299
Age group
11
E-bulletin 13 – VISU April 2016
All ages
Table 3 provides an overview of the severity of unintentional injury hospital admissions by age
group. Serious injury cases are defined using the International Classification of Disease based
Injury Severity Score (ICISS) which reflects threat to life (see Box 1 in Appendix 1, page 38).



Adults aged 25-64 years and older adults aged 65+ each accounted for around 38% of
unintentional injury hospital admissions in 2014/15, while children (0-14 years) and adolescents
& young adults (15-24 years) each accounted for around 12% of injury admissions.
Older adults aged 65+ years accounted for more than three quarters of serious injury
admissions (83.1%, n=11,985). They also accounted for the majority of hospital bed-days (70%,
421,556 days).
Those aged 75-94 years accounted for more than a quarter of all unintentional injury hospital
admissions (26.5%) and were particularly over-represented when serious injuries and bed-days
are taken into account (66.7% and 54.2%, respectively).
Table 3:
Unintentional injury hospital admissions by age group: frequency, serious
injury cases and hospital bed days (2014/15)
Frequency
0-4
5-9
10-14
0-14
15-19
20-24
15-24
25-34
35-44
45-54
55-64
25-64
65-74
75-84
85-94
95+
65+
Total
n
4,638
4,330
4,217
13,185
5,699
6,617
12,316
10,777
9,020
9,174
8,875
37,846
8,947
11,260
11,265
1,322
32,794
96,141
Serious injury cases
%
4.3
3.9
3.8
12.0
5.4
6.2
11.6
10.4
9.1
9.4
9.6
38.5
10.1
13.5
13.0
1.4
37.9
100.0
n
63
43
47
153
198
242
440
426
437
463
527
1,853
1,730
4,177
5,444
634
11,985
14,431
%
0.4
0.3
0.3
1.1
1.4
1.7
3.0
3.0
3.0
3.2
3.7
12.8
12.0
28.9
37.7
4.4
83.1
100.0
Hospital bed-days
n
6,045
5,747
6,254
18,046
11,687
15,241
26,928
24,859
26,751
35,729
47,999
135,338
78,149
154,132
172,341
16,934
421,556
601,868
%
1.0
1.0
1.0
3.0
1.9
2.5
4.5
4.1
4.4
5.9
8.0
22.5
13.0
25.6
28.6
2.8
70.0
100.0
12
All ages
E-bulletin 13 – VISU April 2016
Trend



During the 11-year period 2004/05 to 2014/15, there were on average 72,135 injury
admissions and at least 274,306 injury ED presentations in Victoria per year. The average
age-standardised annual rates per 100,000 population were 1,288 admissions and 5,106
ED presentations.
The age-standardised annual rate of injury admissions increased by 3.30% per year during
the eleven years (Figure 3). The modelled trend in rate showed a statistically significant
annual increase of 2.94% [95%CI 2.06 to 3.84%].
The age-standardised annual rate of injury ED presentations increased by 1.20% per year
(Figure 4). The modelled trend in rate showed a statistically significant annual increase of
0.58% [95%CI 0.11 to 1.04%].
Figure 3: Trend in injury hospital admission rates
per 100,000 population, Victoria
2004/05-2014/15
Figure 4: Trend in injury ED presentation rates
per 100,000 population, Victoria
2004/05-2014/15
13
E-bulletin 13 – VISU April 2016
All ages
Hospital treated injury - gender and age



Males were overrepresented accounting for 55% of all injury admissions (n= 52,630) and 58%
of ED presentations (n=183,327) in Victoria in 2014/15.
Seventy-four percent (n=70,640) of hospital admissions occurred among persons aged 25
years and older; around half of those admitted were aged 25-64 years (n=37,846) and the other
half were aged 65 years and older (n= 32,794). Adults aged 25-64 years accounted for 40% of
ED presentations (n=125,221).
Males accounted for more hospital admissions and ED presentations than women in all age
groups, except the 65 years and older group where females accounted for more hospital
admissions and ED presentations (Figure 5 & Figure 6).
Figure 5:
Hospital injury admissions by gender
and age, Victoria 2014/15
Figure 6:
ED injury presentations by gender
and age, Victoria 2014/15
14
E-bulletin 13 – VISU April 2016
All ages

The all ages rates of hospital injury admission and ED presentation was higher for males than
females: 1,808.3/100,000 vs. 1,462.4/100,000 for admissions and 6,298.9/100,000 vs
4,424.4/100,000 for ED presentations.
The age-specific hospital admission rate was highest in older adults (3,735.6 per 100,000
persons) and lowest in adults (1,201.7 per 100,000 persons), whereas the ED presentation rate
was highest in children (8,422.8/100,000) and lowest in adults (3,976.1/100,000) (Table 4).

Table 4:
Frequency, age-specific and age standardised rates of injury hospital admissions and ED
presentations by gender and age, Victoria 2014/15
Age group
Sex
Hospital admissions
n
0-14 years
25-64 years
65+ years
All
n
Rate per
100,000
persons
Age standardised
rate per 100,000
persons
Male
8,073
1,460.3
1467.1
52,078
9,420.1
9448.8
Female
5,112
975.0
968.2
38,648
7,371.2
7359.8
All
15-24 years
Rate per Age standardised
100,000 rate per 100,000
persons
persons
ED presentations
13,185
1,224.1
1224.3
90,726
8,422.8
8432.4
Male
9,065
2,265.0
2265.8
37,021
9,250.1
9305.6
Female
3,251
853.1
853.3
18,214
4,779.3
4803.3
All
12,316
1,576.3
1577.0
55,235
7,069.4
7109.6
Male
23,891
1,537.7
1535.7
75,914
4,886.0
4906.6
Female
13,955
874.6
855.3
49,307
3,090.1
3079.8
All
37,846
1,201.7
1192.5
125,221
3,976.1
3985.7
Male
11,601
2,873.5
2697.5
18,314
4,536.3
4391.3
Female
21,193
4,469.7
4363.5
25,465
5,370.7
5300.6
All
32,794
3,735.6
3590.8
43,779
4,987.0
4882.2
Male
52,630
1,808.3
1758.0
183,327
6,298.9
6400.0
Female
43,511
1,462.4
1383.8
131,634
4,424.4
4447.7
All
96,141
1,633.5
1563.9
314,961
5,351.3
5411.4
15
E-bulletin 13 – VISU April 2016
All ages
Leading causes of injury






Four of the five major causes of hospital injury admissions and ED presentations were the
same (falls, transport, hit/struck/crush injuries, cutting/piercing), but the ranking on frequency of
cases was different (Figure 7 & Figure 8).
The leading cause of both hospital admissions and ED presentations was falls. Falls accounted
for 47% (n=44,748) of hospital admissions and 38% (n=118,858) of ED presentations.
Transport accounted for 11% of admissions (n=10,280) but just 7% of presentations (n=21,489)
which indicates that transport injuries were more severe than injuries from other causes.
Hit/struck/crush injuries accounted for 9% of admissions (n=8,507) but a higher proportion of
ED presentations (18%, n=57,215).
Cutting and piercing injuries accounted for 7% of admissions (n=6,848) and 8% of ED
presentations (n=26,292).
The fifth ranking cause of hospital admissions was overexertion and/or strenuous movements
related injury (3%, n=3,184) whereas for ED presentations it was injuries caused by a foreign
body in a natural orifice e.g. ear, nose, eye (4%, n=13,082).
Figure 7:
Hospital injury admissions by cause,
Victoria 2014/15
Figure 8:
ED injury presentations by cause,
Victoria 2014/15
Note: “Other specified’ and ‘unspecified’ cases were included in the ‘all other injuries’ category regardless of their ranking
Major injury type (body site and nature of injury)
Figure 9 & Figure 10 show the five most common specific injury types for hospital admissions and
ED presentations.
 Fracture to the upper limb accounted for 19% (n=17,957) of hospital admissions and 12%
(n=37,111) of ED presentations.
 Fracture to the lower limb was the second most common type of injury requiring hospital
admission (14%, n=13,609).
 Dislocations, sprains and strains to the lower limb (9%, n= 29,541) and upper limb (8%,
n=26,304) were common among ED presentations.
 Fracture to the trunk and open wounds to the head/face/neck each accounted for 6% of
hospital admissions (n=5,973 and n=5,445); open wound to upper limb and head/face/neck
each accounted for 7% (n=22,170 and n=20,797) of ED presentations.
16
E-bulletin 13 – VISU April 2016
All ages
Figure 9:
Major injury type, hospital
admissions, Victoria 2014/15
Figure 10:
Major injury type, ED presentations
Victoria 2014/15
Setting


Twenty-six percent (n=24,639) of all injuries requiring hospital admission and 39% (n=95,486)
of injuries resulting in ED presentation occurred in the home.
Persons were also commonly injured on roads/streets/highways (11% of admissions and 7% of
ED presentations), while working for income (7% of admissions and 9% of ED presentations)
and in sports and athletics areas (7% of admissions and 9% of ED presentations). Around 6%
of admissions resulted from injuries that occurred in residential institutional settings (Figure 11
& Figure 12).
Figure 11:
Hospital injury admissions by
setting, Victoria 2014/15
Figure 12:
ED injury presentations by setting,
Victoria 2014/15
17
E-bulletin 13 – VISU April 2016
All ages
Table 5: Ranking of causes of injury hospital admissions by age groups
Age groups (years)
Rank
1
2
3
0-4
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
fall
2,205
47.5%
hit/struck/crush
fall
2,459
56.8%
hit/struck/crush
fall
1,697
40.2%
hit/struck/crush
transport
1,234
21.7%
fall
transport
1,535
23.2%
fall
transport
2,340
21.7%
fall
transport
2,034
22.5%
fall
fall
2,750
30.0%
transport
fall
3,985
44.9%
transport
fall
5,497
61.4%
transport
763
16.5%
unspec. unintent.
615
14.2%
transport
756
17.9%
transport
1,154
20.2%
hit/struck/crush
295
382
688
1,053
6.4%
8.8%
16.3%
18.5%
cutting/ piercing unspec. unintent. unspec. unintent. unspec. unintent.
1,255
1,147
1,985
2,012
1,834
846
17.3%
18.4%
22.3%
20.0%
14.1%
9.5%
unspec. unintent. unspec. unintent. unspec. unintent. unspec. unintent. unspec. unintent. unspec. unintent.
1,043
15.8%
hit/struck/crush
1,717
15.9%
hit/struck/crush
1,284
14.2%
cutting/ piercing
1,235
13.5%
cutting/ piercing
1,034
11.7%
cutting/ piercing
823
9.2%
cutting/ piercing
434
4.9%
ovrext./
stren.mmts
312
3.5%
hit/struck/crush
4
276
6.0%
foreign body
244
5.6%
cutting/ piercing
441
10.5%
cutting/ piercing
991
17.4%
cutting/ piercing
967
14.6%
cutting/ piercing
1,430
13.3%
cutting/ piercing
1,077
11.9%
hit/struck/crush
946
10.3%
hit/struck/crush
734
8.3%
hit/struck/crush
5
270
5.8%
poisoning
205
4.7%
nat./envir./
animals
136
3.1%
foreign body
205
4.9%
ovrext./
stren.mmts
129
3.1%
nat./envir./
animals
95
2.3%
foreign body
501
8.8%
ovrext./
stren.mmts
215
3.8%
nat./envir./
animals
120
2.1%
poisoning
835
12.6%
ovrext./
stren.mmts
312
4.7%
nat./envir./
animals
183
2.8%
poisoning
1,423
13.2%
ovrext./
stren.mmts
517
4.8%
nat./envir./
animals
384
3.6%
poisoning
893
9.9%
ovrext./
stren.mmts
493
5.5%
nat./envir./
animals
375
4.2%
poisoning
710
7.7%
nat./envir./
animals
440
4.8%
ovrext./
stren.mmts
416
4.5%
machinery
547
6.2%
nat./envir./
animals
371
4.2%
ovrext./
stren.mmts
319
3.6%
foreign body
92
2.2%
other spec.
unintent.
57
1.4%
fires/burns/
scalds
24
0.6%
poisoning
108
1.9%
foreign body
171
2.6%
other spec.
unintent.
138
2.1%
machinery
248
2.3%
machinery
251
2.8%
machinery
208
2.3%
poisoning
211
2.0%
other spec.
unintent.
185
1.7%
foreign body
200
2.2%
foreign body
62
1.1%
fires/burns/
scalds
43
0.8%
explosions/
firearms
13
0.2%
drow ning
6
231
5.0%
fires/burns/
scalds
183
3.9%
transport
10
40
0.9%
drow ning
134
3.1%
fires/burns/
scalds
47
1.1%
ovrext./
stren.mmts
32
0.7%
other spec.
unintent.
26
0.6%
poisoning
11
30
0.6%
machinery
24
0.6%
drow ning
21
0.5%
machinery
20
0.4%
other spec.
unintent.
16
0.3%
ovrext./
stren.mmts
*
*
explosions/
firearms
*
*
4,638
12
0.3%
machinery
*
*
choking/ suffoc.
7
0.2%
choking/ suffoc.
*
*
drow ning
*
*
explosions/
firearms
*
*
4,330
*
*
explosions/
firearms
*
*
4,217
7
8
9
12
13
14
15
All
148
3.2%
nat./envir./
animals
146
3.1%
choking/suffoc.
75-84
85-94
95+
fall
fall
fall
8,840
9,808
1,209
78.5%
87.1%
91.5%
unspec. unintent. unspec. unintent. unspec. unintent.
622
5.5%
transport
512
4.5%
transport
39
3.0%
hit/struck/crush
576
5.1%
ovrext./
stren.mmts
255
2.3%
hit/struck/crush
266
2.4%
hit/struck/crush
20
1.5%
ovrext./
stren.mmts
11
0.8%
transport
246
2.2%
cutting/ piercing
203
1.8%
ovrext./
stren.mmts
159
1.4%
poisoning
304
3.4%
nat./envir./
animals
250
2.8%
foreign body
172
1.5%
nat./envir./
animals
153
1.4%
poisoning
92
0.8%
nat./envir./
animals
63
0.6%
foreign body
8
0.6%
machinery
183
2.1%
machinery
159
1.8%
poisoning
152
1.3%
foreign body
57
0.5%
cutting/ piercing
7
0.5%
choking/ suffoc.
207
2.3%
foreign body
155
1.7%
poisoning
118
1.3%
machinery
65
1.0%
explosions/
firearms
15
0.2%
choking/ suffoc.
156
1.4%
fires/burns/
scalds
149
1.4%
explosions/
firearms
21
0.2%
choking/ suffoc.
185
2.0%
other spec.
unintent.
107
1.2%
fires/burns/
scalds
105
1.1%
explosions/
firearms
14
0.2%
choking/ suffoc.
149
1.7%
fires/burns/
scalds
79
0.9%
other spec.
unintent.
33
0.4%
choking/ suffoc.
74
0.8%
fires/burns/
scalds
68
0.8%
other spec.
unintent.
28
0.3%
choking/ suffoc.
38
0.3%
fires/burns/
scalds
24
0.2%
choking/ suffoc.
*
*
cutting/ piercing
130
1.4%
fires/burns/
scalds
127
1.4%
other spec.
unintent.
103
1.1%
explosions/
firearms
23
0.3%
choking/ suffoc.
111
1.0%
fires/burns/
scalds
54
0.5%
machinery
41
0.4%
other spec.
unintent.
24
0.2%
choking/ suffoc.
18
0.2%
other spec.
unintent.
15
0.1%
machinery
*
*
drow ning
*
*
drow ning
13
0.1%
drow ning
*
*
drow ning
25
0.3%
explosions/
firearms
*
*
drow ning
*
*
explosions/
firearms
*
*
drow ning
10
0.1%
drow ning
*
*
choking/ suffoc.
22
0.2%
explosions/
firearms
*
*
drow ning
2
*
nat./envir./
animals
*
*
other spec.
unintent.
*
*
fires/burns/
scalds
*
*
drow ning
*
*
5,699
*
*
6,617
*
*
10,777
5
0.1%
9,020
*
*
9,174
*
*
8,875
*
*
8,947
0
0.0%
11,260
0
0.0%
explosions/
firearms
0
0.0%
11,265
0
0.0%
explosions/
firearms
0
0.0%
1,322
100
1.8%
other spec.
unintent.
98
1.7%
machinery
113
1.7%
fires/burns/
scalds
84
1.3%
foreign body
11
0.8%
foreign body
7
0.5%
poisoning
18
E-bulletin 13 – VISU April 2016
All ages
Table 6: Ranking of causes of injury ED presentations by age groups
Age groups (years)
Rank
1
2
3
0-4
5-9
10-14
15-19
20-24
25-34
35-44
45-54
55-64
65-74
75-84
85-94
95+
fall
fall
fall
fall
fall
fall
fall
fall
fall
fall
fall
fall
fall
14,319
43.9%
hit/struck/crush
13,869
51.1%
hit/struck/crush
13,694
44.3%
hit/struck/crush
8,232
30.1%
hit/struck/crush
6,687
24.0%
hit/struck/crush
9,848
23.2%
hit/struck/crush
8,408
25.8%
hit/struck/crush
8,342
29.8%
hit/struck/crush
8,493
38.3%
hit/struck/crush
8,242
48.3%
other spec.
unintent.
5,440
16.7%
other spec.
unintent.
5,204
19.2%
other spec.
unintent.
8,090
26.1%
other spec.
unintent.
7,616
27.8%
other spec.
unintent.
6,483
23.3%
cutting/piercing
9,042
21.3%
cutting/piercing
5,831
17.9%
cutting/piercing
4,209
15.1%
other spec.
unintent.
2,619
11.8%
other spec.
unintent.
1,831
10.7%
unspec. unintent.
1,340
9.1%
other spec.
unintent.
852
7.9%
other spec.
unintent.
83
7.0%
other spec.
unintent.
3,114
11.4%
transport
3,337
12.0%
other spec.
unintent.
5,443
12.8%
other spec.
unintent.
4,004
12.3%
other spec.
unintent.
3,192
11.4%
cutting/piercing
2,379
10.7%
cutting/piercing
1,646
9.6%
hit/struck/crush
1,176
8.0%
hit/struck/crush
570
5.3%
hit/struck/crush
47
4.0%
hit/struck/crush
1,379
8.1%
cutting/piercing
1,305
7.6%
transport
973
5.7%
foreign body
814
5.5%
cutting/piercing
568
3.9%
transport
522
3.6%
foreign body
448
4.1%
transport
214
2.0%
cutting/piercing
195
1.8%
foreign body
40
3.4%
cutting/piercing
18
1.5%
poisoning
8
0.7%
foreign body
3,980
2,475
3,396
12.2%
9.1%
11.0%
unspec. unintent. unspec. unintent. unspec. unintent.
2,265
6.9%
foreign body
2,069
6.3%
cutting/piercing
1,387
4.3%
fires/burns/
scalds
1,414
5.2%
cutting/piercing
1,357
5.0%
foreign body
918
3.4%
transport
1,853
6.0%
transport
1,552
5.0%
cutting/piercing
1,267
4.1%
nat./envir./
animals
1,196
3.7%
nat./envir./
animals
873
3.2%
nat./envir./
animals
382
1.2%
foreign body
548
2.0%
fires/burns/
scalds
1,022
3.7%
nat./envir./
animals
2,179
5.1%
nat./envir./
animals
1,935
5.9%
nat./envir./
animals
1,802
6.4%
nat./envir./
animals
1,182
5.3%
nat./envir./
animals
695
4.1%
nat./envir./
animals
301
2.0%
nat./envir./
animals
88
0.8%
nat./envir./
animals
7
0.6%
transport
8
834
2.6%
poisoning
545
2.0%
fires/burns/
scalds
336
1.1%
fires/burns/
scalds
472
1.7%
nat./envir./
animals
684
2.5%
fires/burns/
scalds
1,195
2.8%
fires/burns/
scalds
990
3.0%
fires/burns/
scalds
876
3.1%
fires/burns/
scalds
719
3.2%
fires/burns/
scalds
452
2.6%
fires/burns/
scalds
227
1.5%
poisoning
79
0.7%
poisoning
6
0.5%
nat./envir./
animals
9
675
2.1%
transport
325
1.2%
poisoning
233
0.8%
poisoning
437
1.6%
poisoning
601
2.2%
poisoning
973
2.3%
poisoning
746
2.3%
poisoning
614
2.2%
machinery
359
1.6%
machinery
216
1.3%
poisoning
111
0.8%
fires/burns/
scalds
57
0.5%
fires/burns/
scalds
*
*
drow ning
10
338
1.0%
choking/suffoc.
115
0.4%
choking/suffoc.
99
0.3%
machinery
349
1.3%
machinery
499
1.8%
machinery
648
1.5%
machinery
460
1.4%
machinery
353
1.3%
poisoning
239
1.1%
poisoning
178
1.0%
machinery
109
0.7%
machinery
27
0.2%
machinery
*
*
fires/burns/
scalds
55
0.2%
drow ning
42
0.1%
machinery
*
*
explosions/
firearms
23
0.1%
machinery
23
0.1%
drow ning
*
*
explosions/
firearms
21
0.1%
choking/suffoc.
13
0.0%
drow ning
*
*
explosions/
firearms
123
0.4%
choking/suffoc.
31
0.1%
drow ning
15
0.1%
explosions/
firearms
243
0.9%
choking/suffoc.
25
0.1%
drow ning
*
*
explosions/
firearms
442
1.0%
choking/suffoc.
53
0.1%
drow ning
*
*
explosions/
firearms
353
1.1%
choking/suffoc.
39
0.1%
drow ning
14
0.0%
explosions/
firearms
330
1.2%
choking/suffoc.
38
0.1%
drow ning
10
0.0%
explosions/
firearms
232
1.0%
choking/suffoc.
21
0.1%
drow ning
*
*
explosions/
firearms
128
0.8%
choking/suffoc.
11
0.1%
drow ning
*
*
explosions/
firearms
56
0.4%
choking/suffoc.
*
*
drow ning
*
*
explosions/
firearms
7
0.1%
choking/suffoc.
5
0.0%
drow ning
0
0.0%
explosions/
firearms
*
*
machinery
*
*
choking/suffoc.
0
0.0%
explosions/
firearms
*
*
32,628
*
*
27,152
*
*
30,946
7
0.0%
27,389
*
*
27,846
*
*
42,446
9
0.0%
32,648
6
0.0%
27,961
*
*
22,166
*
*
17,060
0
0.0%
14,704
0
0.0%
10,830
0
0.0%
1,185
4
5
6
7
11
12
13
14
All
2,384
3,030
4,806
3,816
3,159
2,210
8.7%
10.9%
11.3%
11.7%
11.3%
10.0%
cutting/piercing
transport
transport
transport
unspec. unintent. unspec. unintent.
2,042
3,024
4,290
3,156
2,533
2,042
7.5%
10.9%
10.1%
9.7%
9.1%
9.2%
unspec. unintent. unspec. unintent. unspec. unintent. unspec. unintent.
transport
transport
2,019
2,199
3,513
2,887
2,497
1,660
7.4%
7.9%
8.3%
8.8%
8.9%
7.5%
foreign body
foreign body
foreign body
foreign body
foreign body
foreign body
9,469
8,288
967
64.4%
76.5%
81.6%
unspec. unintent. unspec. unintent. unspec. unintent.
19
E-bulletin 13 – VISU April 2016
Children
Children (0-14 years)
Trend





During the 11-year period 2004/05 to 2014/15 there were on average 10,114 injury
admissions and 75,899 injury ED presentations per year among children aged 14 years or
younger. The average age-standardised injury rates were 1,005 admissions and 7,527 ED
presentations per 100,000 children per year.
The age-standardised annual rate of injury admissions among children aged 0-14 years
increased by 2.50% per year during the eleven years. The modelled trend in rate showed a
statistically significant annual increase of 1.78% [95%CI 0.60 to 2.68%].
The age-standardised rate of injury ED presentations among children aged 0-14 years
increased by 2.12% per year. The modelled trend in rate showed a statistically significant
annual increase of 1.19% [95%CI 0.61 to 1.77%].
The modelled age-specific rates of injury admissions among the age groups 0-4, 5-9 and
10-14 years showed annual increases of 2.3%, 1.6% and 1.5%, respectively (each
statistically significant) (age specific rates shown in Figure 13).
The modelled age-specific rate of injury ED presentations among the age groups 0-4, 5-9
and 10-14 years showed annual increases of 0.7% (not significant), 1.6% and 1.5% (both
statistically significant), respectively (age specific rates shown in Figure 14).
Figure 13: Trend in injury hospital admission rates
per 100,000 children,
Victoria 2004/05-2014/15
Figure 14: Trend in injury ED presentation rates
per 100,000 children,
Victoria 2004/05-2014/15
20
E-bulletin 13 – VISU April 2016
Children
2015
Hospital treated injury - gender and age


Males were overrepresented in child hospital-treated injury cases, accounting for 61% of hospital
admissions (n=8,073) and 57% of ED presentations (n=52,078) in Victoria in 2014/15 (Figure 15
& Figure 16).
Child injury hospital admissions and ED presentations were fairly evenly distributed across the 5year age groups.
- Children aged 0-4 years accounted for 35% of child admissions and 36% of child ED
presentations.
- Children aged 5-9 years accounted for 33% of child admissions and 30% of child ED
presentations.
- Children aged 10-14 years accounted for 32% of child admissions and 34% of child ED
presentations.
Figure 15: Child injury hospital admissions by
gender and age, Victoria 2014/15


Child injury ED presentations by
gender and age, Victoria 2014/15
The age-specific child hospital injury admission and ED presentation rates were higher for males
than females: 1.460.3 vs. 975.0/100,000 (admissions) and 9,420.1 vs. 7,371.2/100,000
(presentations).
Table 7 shows that age-specific hospital admission rates were fairly equal across age groups
whereas there was a high rate of ED presentations in the 10-14 age group followed by the 0-4
age group.
Table 7:
Frequency and age-specific rate of hospital injury admissions and ED presentations in
children by gender and age, Victoria 2014/15
Age group
0-4 years
5-9 years
10-14 years
All
Figure 16:
Sex
Male
Female
All
Male
Female
All
Male
Female
All
Male
Female
All
Hospital admissions
Rate per 100,000
n
persons
2,690
1,390.2
1,948
1,064.8
4,638
1,232.0
2,513
1,351.6
1,817
1,030.5
4,330
1,195.3
2,870
1,655.0
1,347
816.1
4,217
1,245.9
8,073
1,460.3
5,112
975.0
13,185
1,224.1
ED presentations
Rate per 100,000
n
persons
18,371
9,494.1
14,257
7,792.9
32,628
8,667.4
15,031
8,084.6
12,121
6,874.4
27,152
7,495.5
18,676
10,769.4
12,270
7,434.3
30,946
9,143.1
52,078
9,420.1
38,648
7,371.2
90,726
8,422.8
21
E-bulletin 13 – VISU April 2016
Children
2015
Leading causes of injury





The five leading causes of hospital injury admissions and ED presentations in children were the
same although the ranking on frequency of cases was different (Figure 17 & Figure 18).
The leading cause of child hospital admissions and ED presentations was falls accounting for
48% (n=6,361) of hospital admissions and 46% (n=41,882) of ED presentations.
Hit/struck/crush injuries were the next major cause of injury accounting for 16% of admissions
(n=2,134) and 21% of ED presentations (n=18,734).
Transport accounted for 9% of admissions (n=1,218) and only 3% of ED presentations
(n=2,763).
Foreign body in a natural orifice e.g. ear, nose, eye injuries and cutting and piercing related
injuries accounted for 4% and 5% of admissions (n=496 & n=686) and 4% each of ED
presentations (n=3,323 & n=4,011).
Figure 17:
Child injury hospital admissions by
cause, Victoria 2014/15
Figure 18: Child injury ED presentations by
cause, Victoria 2014/15
Note: ‘Other specified’ and ‘unspecified’ cases were included in the ‘all other injuries’ category regardless of their ranking
22
E-bulletin 13 – VISU April 2016
Children
2015
Major injury type (body site and nature of injury)
Figure 19 & Figure 20 show the five major injury types for child hospital injury admissions and ED
presentations.
 Fracture to the upper limb accounted for 31% (n=4,040) of child hospital injury admissions and
17% (n=15,741) of ED presentations.
 Open wounds to the head/face/neck accounted for 12% (n=1,632) of admissions and 13%
(n=10,946) of ED presentations.
 Fracture to the lower limb (6%, n=782) and intracranial injury (5%, n=722) were common among
hospital admissions, whereas dislocations, sprains & strains to the upper limb (12%, n=10,501),
and the lower limb (8%, n=6,525) and superficial injury to head/face/neck (7%, n=6,130) were
common among ED presentations.
Figure 19:
Major injury type, child hospital
admissions, Victoria 2014/15
Figure 20:
Major injury type, child ED
presentations, Victoria 2014/15
23
E-bulletin 13 – VISU April 2016
Children
2015
Setting


Twenty-four percent (n=3,133) of all injuries among children requiring hospital admission and
46% (n=41,614) of injuries resulting in ED presentation occurred in the home (Figure 21 & Figure
22).
Children were also commonly injured in schools and educational settings (12% of admissions
and 13% of ED presentations) and sports and athletics areas (10% of admissions and 10% of ED
presentations).
Figure 21:
Child injury hospital admissions by
setting, Victoria 2014/15
Figure 22:
Child injury ED presentations by
setting, Victoria 2014/15
24
Adolescents and young adults
E-bulletin 13– VISU April 2016
Adolescents and young adults (15-24 years)
Trend





During the 11-year period 2004/05 to 2014/15, there were on average 9,876 injury
admissions and 52,038 injury ED presentations per year among adolescents and young
adults aged 15-24 years. The average age-standardised injury rates were 1,324 admissions
and 7,013 ED presentations per 100,000 adolescents and young adults per year.
The age-standardised annual rate of injury admissions among adolescents and young
adults increased by 2.77% per year during the eleven years. The modelled trend in rate
showed a statistically significant annual increase of 2.16% [95%CI 1.44 to 2.88%].
The age-standardised rate of injury ED presentations among adolescents and young
adults increased by 0.58% per year. The modelled trend in rate showed a non-significant
annual decrease of -0.07% [95%CI -0.51 to 0.38%].
The modelled age-specific rates of injury admissions among the age groups 15-19 and
20-24 years showed annual increases of 1.8% and 2.5%, respectively (each statistically
significant) (age specific rates shown in Figure 23).
The modelled age-specific rates of injury ED presentations among the age groups 15-19
and 20-24 years showed an annual increase of 0.3% (not significant) and a decrease of 0.4% (not significant) respectively (age specific rates shown in Figure 24).
Figure 23: Trend in injury hospital admission rates
per 100,000 adolescent & young adults,
Victoria 2004/05-2014/15
Figure 24: Trend in injury ED presentation rates
per 100,000 adolescent & young
adults, Victoria 2004/05-2014/15
25
Adolescents and young adults
E-bulletin 13– VISU April 2016
Hospital treated injury - gender and age


Males were overrepresented in hospital-treated injury cases among adolescents and young
adults, accounting for 74% of hospital admissions (n=9,065) and 67% of ED presentations
(n=37,021) in Victoria in 2014/15 (Figure 25 & Figure 26).
Adolescent and young adult injury hospital admissions and ED presentations were fairly evenly
spread across both the 5-year age groups.
Figure 25: Adolescent and young adult hospital
admissions by gender and age,
Victoria 2014/15


Adolescent and young adult ED
presentations by gender and age,
Victoria 2014/15
Among adolescent and young adults, age-specific hospital injury admission and ED presentation
rates were higher for males than females: 2,265.0 vs. 853.1/100,000; 9,250.1 vs. 4,779.3
/100,000 (Table 8).
The admission rates were quite similar across the two 5-year age groups while the ED
presentation rate was higher in the 15-19 age group than the 20-24 age group.
Table 8:
Frequency and age-specific rate of hospital injury admissions and ED presentations
in adolescents and young adults by gender and age, Victoria 2014/15
Age group
15-19 years
20-24 years
All
Figure 26:
Sex
Hospital admissions
ED presentations
n
Rate per 100,000
persons
n
Rate per 100,000
persons
Male
4,200
2,276.5
18,440
9,994.9
Female
1,499
856.7
8,949
5,114.3
All
5,699
1,585.4
27,389
7,619.2
Male
4,865
2,255.2
18,581
8,613.2
Female
1,752
850.0
9,265
4,495.0
All
6,617
1,568.6
27,846
6,601.0
Male
9,065
2,265.0
37,021
9,250.1
Female
3,251
853.1
18,214
4,779.3
12,316
1,576.3
55,235
7,069.4
All
26
Adolescents and young adults
E-bulletin 13– VISU April 2016
Leading causes of injury






Four of the five leading causes of adolescent and young adult hospital injury admissions and ED
presentations were the same although the ranking on frequency of cases was different (Figure
27 & Figure 28).
Transport was the leading cause of adolescent and young adult hospital admissions (23%,
n=2,769) but only accounted for 10% of ED presentations (n=5,408).
Falls was the second most common cause of hospital admissions (19%, n=2,301), and the
leading cause of ED presentations (27%, n=14,919) in this age group.
Hit/struck/crush injuries accounted for 16% of hospital admissions (n=2,020) and 26% of ED
presentations (n=14,099).
Cutting and piercing injuries accounted for 11% of admissions (n=1,336) and 10% of ED
presentations (n=5,379).
The fifth ranking cause of adolescent and young adult hospital admissions was overexertion and
strenuous movements (4%, n=527) whereas for ED presentations it was injuries caused by a
foreign body in a natural orifice e.g. ear, nose, eye (3%, n=1,570).
Figure 27:
Adolescent and young adult injury
hospital admissions by cause,
Victoria 2014/15
Figure 28: Adolescent and young adult injury ED
presentations by cause,
Victoria 2014/15
Note: ‘Other specified’ and ‘unspecified’ cases were included in the ‘all other injuries’ category regardless of their ranking
27
Adolescents and young adults
E-bulletin 13– VISU April 2016
Major injury type (body site and nature of injury)
Figure 29 & Figure 30 show the five major specific injury types for adolescent and young adult
hospital admissions and ED presentations.
 Fracture to the upper limb accounted for 20% (n=2,500) of hospital injury admissions and 10% of
ED presentations (n=4,748).
 Fracture to the lower limb (9%, n=1,116) and dislocations, sprains and strains to the lower limb
(10%, n=1,184) were common among admissions.
 Dislocations, sprains and strains to the lower limb (15%, n=8,101), and the upper limb (10%,
n=5,738) and open wounds to the upper limb (8%, n=4,602) were common among ED
presentations.
Figure 29:
Major injury type, adolescent and
young adult hospital admissions,
Victoria 2014/15
Figure 30: Major injury type, adolescent and
young adult ED presentations,
Victoria 2014/15
28
Adolescents and young adults
E-bulletin 13– VISU April 2016
Setting


Sports (22%, n=2,714) and the road, street and highway (14%, n=1,710) settings were the most
common places of occurrence of adolescent and young adult injuries resulting in hospital
admission (Figure 31). Other common settings were working for income (10%, n=1,205) and the
home (8%, n=960).
Among ED presentations, the home (24%, n=13,017) and sports settings (21%, n=11,505) were
the most common places of injury occurrence (Figure 32). Other common settings were working
for income (12%, n=6,375) and road/street and highway (9%, n=4,987).
Figure 31:
Adolescent and young adult
injury hospital admissions by
setting, Victoria 2014/15
Figure 32:
Adolescent and young adult injury
ED presentations by setting,
Victoria 2014/15
29
Adults
2015
E-bulletin 13– VISU April 2016
Adults (25-64 years)
Trend





During the 11-year period 2004/05 to 2014/15, there were on average 28,289 injury
admissions and 111,533 injury ED presentations per year among adults aged 25-64 years.
The average age-standardised injury rates were 966 admissions and 3,870 ED
presentations per 100,000 adults per year.
The age-standardised annual rate of injury admissions among adults increased by 3.69%
per year during the eleven years. The modelled trend in rate showed a statistically
significant annual increase of 3.38% [95%CI 2.52 to 4.24%].
The age-standardised rate of injury ED presentations among adults increased by 0.68%
per year. The modelled trend in rate showed a non-significant annual increase of 0.24%
[95%CI -0.31 to 0.79%].
The modelled age-specific rates of injury admissions among the age groups 25-29, 30-34,
35-39, 40-44, 45-49, 50-54, 55-59, and 60-64 years showed annual increases of 2.2, 2.0,
2.4, 3.7, 4.0, 4.7, 4.1, and 4.4%, respectively (each statistically significant) (age specific
rates shown in Figure 33).
The modelled age-specific rates of injury ED presentations showed annual decreases of 0.9% (marginally significant), -1.2% (significant) and -0.5% (not significant), in the age
groups 25-29, 30-34, 35-39 years. In the age groups 40-44, 45-49, 50-54, 55-59, and 60-64
years, modelled rates increased statistically significantly by 0.7, 1.1, 1.8, 1.4 and 1.7%,
respectively (age specific rates shown in Figure 34).
Figure 33: Trend in injury hospital admission rates
per 100,000 adults,
Victoria 2004/05-2014/15
Figure 34: Trend in injury ED presentation rates
per 100,000 adults,
Victoria 2004/05-2014/15
30
Adults
2015
E-bulletin 13– VISU April 2016
Hospital treated injury - gender and age


Males were overrepresented in hospital injury data for adults aged 25 to 64 years, accounting
for 63% of hospital admissions (n=23,891) and 61% of ED presentations (n=75,914) in Victoria
in 2014/15 (Figure 35 & Figure 36).
The proportion of injuries was fairly evenly distributed among all age groups for admissions
whereas a gradual decrease can be seen with increase in age for ED presentations.
Figure 35:


Adult injury hospital admissions by
gender and age, Victoria 2014/15
Adult injury ED presentations by
gender and age, Victoria 2014/15
The age-specific hospital injury admission and ED presentation rates were higher for males
compared with females: 1,537.7 vs. 874.6 /100,000 adults (admissions) and 4,886.0 vs.
3,090.1 /100,000 adults (presentations).
Overall rates (male and female combined) were highest in the 55-64 years age group for
admissions and the 25-34 years group for ED presentations (Table 9).
Table 9:
Frequency and age-specific rate of hospital injury admissions and ED presentations in
adults by gender and age, Victoria 2014/15
Age group
25-34 years
Sex
35-44 years
45-54 years
55-64 years
Hospital admissions
ED presentations
n
Rate per 100,000
persons
n
Rate per 100,000
persons
Male
7,620
1,702.5
27,567
6,159.1
Female
3,157
700.7
14,879
3,302.5
10,777
1,199.9
42,446
4,726.1
Male
6,000
1,490.6
20,405
5,069.2
Female
3,020
731.6
12,243
2,965.8
All
9,020
1,106.3
32,648
4,004.3
Male
5,654
1,489.1
16,341
4,303.8
Female
3,520
895.7
11,620
2,956.9
All
9,174
1,187.3
27,961
3,618.8
Male
4,617
1,425.4
11,601
3,581.6
Female
4,258
1,254.8
10,565
3,113.5
All
8,875
1,338.2
22,166
3,342.1
Male
23,891
1,537.7
75,914
4,886.0
Female
13,955
874.6
49,307
3,090.1
All
37,846
1,201.7
125,221
3,976.1
All
All
Figure 36:
31
Adults
2015
E-bulletin 13– VISU April 2016
Leading causes of injury






Four of the five leading causes of adult hospital injury admissions and ED presentations were the
same although the ranking on frequency of cases was different (Figure 37 & Figure 38).
The leading cause of adult hospital admissions and ED presentations was falls accounting for
28% (n=10,732) of hospital admissions and 28% (n=35,091) of ED presentations.
Transport accounted for 20% of admissions (n=7,463) but only 9% of presentations (n=11,603).
Cutting and piercing injuries accounted for 11% of admissions (n=4,180) and 12% of ED
presentations (n=14,816).
Hit/struck/crush injuries accounted for just 10% of admissions (n=3,580) but 17% of ED
presentations (n=21,701).
The fifth ranking cause of hospital admissions was overexertion and/or strenuous movements
related injury (5%, n=1,745) whereas for ED presentations it was injuries caused by a foreign
body in a natural orifice e.g. ear, nose, eye (6%, n=7,098).
Figure 37:
Adult injury hospital admissions by
cause, Victoria 2014/15
Figure 38:
Adult injury ED presentations by
cause, Victoria 2014/15
Note: ‘Other specified’ and ‘unspecified’ cases were included in the ‘all other injuries’ category regardless of their ranking
32
Adults
2015
E-bulletin 13– VISU April 2016
Major injury type (body site and nature of injury)
Error! Reference source not found. & Figure 40Error! Reference source not found. show the
five major specific injury types for adult hospital admissions and ED presentations.
 Fracture to the upper limb accounted for 19% (n=6,982) of adult hospital injury admissions and
9% (n=11,057) of ED presentations.
 Fracture to the lower limb was the second most common type of injury requiring hospital
admission (12%, n=4,473) followed by open wound to upper limb (7%, n=2,801) and dislocations,
sprains and strains to lower limb and injury to muscle and tendon in upper limb (5% each,
n=1,992 & n=1,958).
 Open wounds to the upper limb (10%, n=12,884), dislocations, sprains and strains to the lower
limb (10%, n=12,241) and fracture to the upper limb (9%, n=11,057) were the most common
types of injury among ED presentations.
Figure 39:
Major injury type, adult hospital
admissions, Victoria 2014/15
Figure 40:
Major injury type, adult ED
presentations, Victoria 2014/15
33
Adults
2015
E-bulletin 13– VISU April 2016
Setting


Seventeen percent of injuries requiring hospital admission (n=6,539) and 37% of injuries
resulting in ED presentation (n=46,657) occurred in the home (Figure 41 & Figure 42).
Other settings where injuries to adults commonly occurred were:
- Working for income (13% of admissions (n=4,936) and 15% of ED presentations (n=18,896))
- Roads, streets and highways (14% of admissions (n=5,465) and 10% of ED presentations
(n=12,401))
- Sports and athletics setting (8% of admissions (n=2,851) and 7% of ED presentations
(n=8,164)).
Figure 41:
Adult injury hospital admissions by
setting, Victoria 2014/15
Figure 42:
Adult injury ED presentations by
setting, Victoria 2014/15
34
Older adults
E-bulletin 13 – VISU April 2016
Older adults (65 years and older)
Trend





During the 11-year period 2004/05 to 2014/15, there were on average 23,855 injury
admissions and 34,836 injury ED presentations per year among older adults aged 65 years
and above. The average age-standardised injury rates were 3,006 admissions and 4,498
ED presentations per 100,000 older adults per year.
The age-standardised annual rate of injury admissions among older adults increased by
3.54% per year, during the eleven years. The modelled trend in rate showed a statistically
significant annual increase of 3.49% [95%CI 3.12 to 3.86%].
The age-standardised annual rate of injury ED presentations among older adults
increased by 1.68% per year. The modelled trend in rate showed a statistically significant
annual increase of 1.43% [95%CI 1.12 to 1.74%].
The modelled age-specific rates of injury admissions among the age groups 65-69, 70-74,
75-79, 80-84, 85-89, 90-94 and 95+ years showed annual increases of 4.5, 4.0, 3.3, 2.8,
3.4, 2.8 and 3.5%, respectively (each statistically significant) (age specific rates shown in
Figure 43).
The modelled age-specific rates of injury ED presentations among the age groups 65-69,
70-74, 75-79, 80-84 and 85-89 years showed significant annual increases of 1.6, 1.6, 1.4,
1.5, and 1.4%, respectively. In the 90-94 and 95+ age groups, the average annual
increases of 0.4 and 0.1% (respectively) were not statistically significant (age specific rates
shown in Figure 44).
Figure 43: Trend in injury hospital admission rates
per 100,000 older adults,
Victoria 2004/05-2014/15
Figure 44: Trend in injury ED presentation rates
per 100,000 older adults,
Victoria 2004/05-2014/15
35
E-bulletin 13 – VISU April 2016
Older adults
Hospital treated injury - gender and age


Females were overrepresented in hospital injury data for persons aged 65 years and older. They
accounted for 65% of hospital admissions (n=21,193) and 58% of ED presentations (n=25,465)
in Victoria in 2014/15 (Figure 45 & Figure 46).
The highest proportion of admissions to hospital occurred among those aged 75-84 and 85-94
years. Persons from the 65-74 group accounted for most of the ED presentations, then the
number of ED presentations declined with increasing age beyond 75 years.
Figure 45: Older adult injury hospital admissions
by gender and age, Victoria 2014/15


Frequency and age-specific rate of older adult injury hospital admissions and ED
presentations by gender and age, Victoria 2014/15
Age group
65-74 years
75-84 years
Sex
85-94 years
Hospital admissions
ED presentations
n
Rate per 100,000 persons
Male
3,855
1,640.2
8,224
3,499.0
Female
5,092
2,047.1
8,836
3,552.2
All
8,947
1,849.4
17,060
3,526.4
Male
4,116
3,298.7
6,164
4,940.1
Female
7,144
4,781.0
8,540
5,715.3
11,260
4,106.5
14,704
5,362.5
Male
3,325
7,971.1
3,633
8,709.5
Female
7,940
11,380.2
7,197
10,315.3
11,265
10,104.7
10,830
9,714.5
305
13,901.5
293
13,354.6
Female
1,017
16,384.7
892
14,370.9
All
1,322
15,736.2
1,185
14,105.5
Male
11,601
2,873.5
18,314
4,536.3
Female
21,193
4,469.7
25,465
5,370.7
All
32,794
43,779
4,987.0
All
All
All
Older adult injury ED presentations
by gender and age, Victoria 2014/15
The age-specific rate of hospital injury admission and ED presentation was higher for females
than males: 4,469.7 vs. 2,873.5 /100,000 persons (admissions) and 5,370.7 vs. 4,536.3 /100,000
persons (presentations) (Table 10).
The rate of admissions and ED presentations increased with increasing age.
Table 10:
95+
Figure 46:
Male
3,735.6
n Rate per 100,000 persons
36
E-bulletin 13 – VISU April 2016
Older adults
Leading causes of injury




The leading cause of hospital injury admissions and ED presentations for older adults was falls.
Falls accounted for more than three-quarters of hospital admissions (77%, n=25,354) and more
than half of ED presentations (62%, n=26,966) in this age group (Figure 47 & Figure 48).
Transport was the second most common cause of hospital admission (5%, n=1,699) and the
cause of 4% of presentations (n=1,715). The second most common cause for ED presentations
in this age group was hit/struck/crush (6%, n=2,681).
The third leading cause of admissions was hit/struck/crush (2%, n=773) whereas for ED
presentations it was cutting and piercing (5%, n=2,086).
Overexertion and/or strenuous movements and cutting and piercing each accounted for 2% of
admissions (n=773 & 646) while injuries caused by a foreign body in a natural orifice e.g. ear,
nose, eye accounted for 3% (n=1,091) of ED presentations.
Figure 47: Older adult injury hospital admissions
by cause, Victoria 2014/15
Figure 48:
Older adult injury ED presentations
by cause, Victoria 2014/15
Note: ‘Other specified’ and ‘unspecified’ cases were included in the ‘all other injuries’ category regardless of their ranking
37
E-bulletin 13 – VISU April 2016
Older adults
Major injury type (body site and nature of injury)
Figure 49 & Figure 50 show the five major specific injury types for older adult hospital admissions
and ED presentations.
 Fracture to the lower limb accounted for 22% of hospital injury admissions (n=7,238) and 14%
(n=5,856) of ED presentations.
 Fracture to the upper limb accounted for 13% (n=4,435) of hospital admissions and 11%
(n=4,649) of ED presentations. Fractures to the trunk were also common among hospital
admissions (12%, n=3,879).
 Open wounds to the head/face/neck accounted for 7% (n=2,183) of hospital admissions and 8%
(n=2,774) of ED presentations.
 Dislocations, sprains and strains to the lower limb (6%, n=2,674) and open wound to upper limb
(5%, n=2,353) were also common among ED presentations.
Figure 49:
Major injury type, older adult hospital
admissions, Victoria 2014/15
Figure 50:
Major injury type, older adult ED
presentations, Victoria 2014/15
38
E-bulletin 13 – VISU April 2016
Older adults
Setting


Around 43% of older adult injuries requiring hospital admission (n=14,007) and more than half
of injuries resulting in ED presentations (54%, n=23,777) occurred in the home (Figure 51 &
Figure 52).
Other settings where injuries to older adults commonly occurred were:
- Residential institutions (17% of admissions (n=5,492) and 8% of ED presentations
(n=3,275))
- Trade and service areas (3% of admissions (n=1,001))
- Roads, streets and highways (8% of admissions (n=2,449) and 8% of ED presentations
(n=3,381)).
Figure 51:
Older adult injury hospital admissions
by setting, Victoria 2014/15
Figure 52:
Older adult injury ED presentations
by setting, Victoria 2014/15
39
E-bulletin 13 – VISU April 2016
Appendix 1
Appendix 1
VISU definitions
Definitions
‘Injury’: Injury is commonly defined as: ‘any unintentional or intentional damage to the body ...
caused by acute exposure to physical agents such as mechanical energy, heat, electricity,
chemicals, and ionizing radiation interacting with the body in amounts or at rates that exceed the
threshold of human tolerance’.
‘Unintentional injury’: Injuries that are unintended, often described as ‘accidents’. We try to avoid
using the term ‘accidents’ as it implies that injuries are random events due to chance.
‘Intentional injury’: Injuries that are the result of intended acts by people i.e., harm of one person
by another (assault, homicide, neglect) or self-harm.
An injury ‘death’ is defined as an injury or poisoning by an external cause (transport crash, fall,
suicide, drowning etc.) that results in a person dying either in or out of hospital. In Victoria (and in
other Australian States and Territories) all deaths by external causes must be reported to the State
Coroner.
An injury ‘hospital admission’ is defined as an injury or poisoning that results in the person being
admitted to an inpatient bed (a ward, short stay observation unit, emergency medical unit, medical
assessment and planning unit, intensive care bed, mental health bed or coronary care unit) and
subsequently discharged alive either on the same day (after at least 4 hours from the time patient
management commences) or after one or more nights’ stay in a hospital bed. Prior to July 2012 this
definition included patients who had their entire care within the ED. From July 2012 if the patient’s
entire care was provided within a designated emergency department or urgent care centre then the
patient is no longer classified as an admission.
An injury ‘emergency department (ED) presentation’ is defined as an injury or poisoning that
results in a person presenting to a hospital emergency department for treatment who is triaged
(assessed for urgency), including those patients who leave before treatment commences.
For the purposes of this E-bulletin age groups are defined as follows to match those in the National
Injury Prevention and Safety Promotion Plan. A child is defined as a person aged 0-14 years, an
adolescent and young adult is a person aged 15-24 years, an adult is a person aged 25-64 years
and an older adult is a person aged 65 years and above.
40
Appendix 1
E-bulletin 13 – VISU April 2016
Box 1: Settings definition and injury severity
Settings definitions
The settings are mutually exclusive. For hospital admissions all settings are defined exclusively by location coding except
working for income. Working for income cases are defined by activity code OR compensable status. Further, preference is
given to activity so cases with an activity recorded as working for income are defined as working for income and removed
from the setting of their location code. For ED presentations text descriptions were also used to identify some settings that
were not covered by existing location or activity coding (i.e., area of still water/ stream of water/ large area of water/ beach
& forest/ desert/ other specified countryside).
(1) ‘Home’ includes injuries occurring in homes, drive-ways, apartments, boarding houses, caravans, farmhouses,
swimming pools/tennis courts in private residences.
(2) ‘Sports setting’ includes injuries occurring at any sports and athletics area.
(3) ‘Road/street/highway’ includes injuries occurring on roadways, sidewalks and cycle-ways next to roads.
(4) ‘Residential institution’ includes injuries occurring in prisons, juvenile detention centres, military camps, orphanages,
aged care facilities (nursing home/old people’s home/retirement village). Most hospitalisations for this setting were for
injury occurring in aged care facilities (93%).
(5) ‘Working for income’ includes injuries occurring while the person was engaged in paid work or transportation to and
from such activities.
(6) ‘Health service area’ includes injuries occurring to any person (i.e., patient, visitor) in hospitals, health centres, day
procedure centres, hospices, outpatient clinics. Data presented here exclude ‘medical injuries’ as is normal practice for
VISU injury reports. Persons working for income are not included as they are already counted in the working for income
setting.
(7) ‘Trade and service area’ includes injuries occurring in shops/stores, commercial garages, office buildings,
cafes/hotels/restaurants, airports, bus/radio/railway/television stations.
(8) ‘School & other educational institution’ includes injuries occurring in boarding/residential schools, colleges, day
nurseries, institutes for higher education/universities, kindergartens.
(9) “Other institution & public administrative area’ includes injuries occurring in buildings (including adjacent grounds) used
by the general public such as assembly hall, church, cinema, clubhouse, court house, dancehall, gallery, library, movie
house, museum, music hall, opera house, public hall, theatre, youth centre.
(10) “Area of still water/ stream of water/ large area of water/ beach” includes injuries occurring at a dam, fen,
marsh/swamp, pond, pool, reservoir, brook, canal, creek, river, stream, bay, lake, ocean, sea, foreshore, sand dunes.
(11) ‘Farm’ includes injuries occurring in farm buildings/ranches or on land under cultivation, excluding the farm home.
(12) “Forest/ desert/ other specified countryside” includes injuries occurring in a forest, desert, cave, gorge, mountain,
outback, prairie, wilderness.
(12) ‘Other specified location’ includes injuries occurring in campsites, public place NOS, park NOS, railway line, zoo,
parking lot, town camps.
(13) ‘Unspecified setting’ includes injuries occurring in an unspecified place of occurrence.
Injury severity: definition of ‘serious’ injury
Each hospital admission record was given an International Classification of Disease (ICD)-based Injury Severity Score
(ICISS) (Osler et al, 1996). The ICISS is a score between 0 and 1 and involves estimating probability of death for ICD
injury diagnosis codes in a patient’s hospital record (Osler et al., 1996).Determining an ICISS score involves calculating a
Diagnosis-specific Survival Probability (DSP) for each individual injury diagnosis, using a large sample of injured people. A
DSP is the proportion of cases with a certain injury diagnosis in which the patient does not die, or in other words, a given
DSP represents the likelihood that a patient will survive a particular injury. Each patient’s final ICISS score can be
calculated by multiplying the probabilities of surviving each of their injuries individually or by using only the probability of
surviving the ‘worst’ injury. A severity threshold can then be used to classify hospitalisations as either ‘serious’ or ‘nonserious’. VISU considers an injury to be ‘serious’ if the ICISS is less than or equal to 0.941, this is equivalent to a survival
probability of 94.1% or worse – meaning the injured person has a probability of death (when admitted) of at least 5.9%
(Davie & Cryer, 2007). For this edition the severity scores have been calculated using DSPs derived using Victorian data.
In addition, only the injury with the highest ‘threat-to-life’ and has been used and the ICISS score has also been adjusted
for age (Clapperton et.al, 2014).
Davie G, Cryer C & Langley J. (2007). Improving the predictive ability of ICD-based injury severity score. Injury
Prevention. 14:250-5.
Osler T, Rutledge R, Deis J & Bedrick E. (1996). ICISS: An International Classification of Disease-9 based Injury Severity
Score. Journal of Trauma: Injury, Infection and Critical Care. 41:380–388.
Stephenson S, Langley J, Henley G & Harrison J. (2003). Diagnosis-based injury severity scaling: a method using
Australian and New Zealand hospital data coded to ICD-10-AM. Injury research and statistics series, no. 20, Australian
Institute of Health and Welfare, Adelaide.
Clapperton A, D’Elia A & Day L. SERIOUS INJURY IN VICTORIA: PART 1: Development and validation of a severity of
injury measure using Victorian administrative data; PART 2: Trends in serious road traffic injury hospitalisations, Victoria,
2000-2012/13. Report to VicRoads, April 2014. Monash Injury Research Institute.
41
E-bulletin 13 – VISU April 2016
Appendix 2
Appendix 2
VISU data sources and case selection
1. Hospital admissions
1.1 Source: Victorian Admitted Episodes Dataset (VAED)
Hospital admission unit record data are annually supplied to VISU by the Victorian Department of
Health and Human Services (DHHS). Injury records are identified by VISU as those with an ICD-10AM injury code (S00-T98) or external cause code (U50-Y98) in any one of the 40 diagnosis codes.
The resultant file is cleaned, checked and merged with the VISU-held VAED dataset.
From July 1998, cases recorded on the VAED are coded to ICD-10-AM, the WHO International
Statistical Classification of Diseases and Related Health Problems, Tenth Revision, Australian
Modification. ICD-10-AM has been developed by the National Centre for Classification in Health in
Queensland with assistance from clinicians and clinical coders to ensure that the classification is
current and appropriate for Australian clinical practice. The Australian Modifications of ICD-10 are
generally updated every two years. Up to June 30 1998, cases were coded to ICD-9-CM. The
external causes chapters of ICD-9-CM and ICD-10-AM describe the causes of injury, poisoning and
adverse events (complications of medical and surgical care). Adverse events and sequelae (late
effects) of external causes of morbidity and mortality are usually not included in VISU reports.
The VAED data items held by VISU include:
1.1.1
Demographic/administrative items




Age, sex, postcode, suburb and local government area of residence
Country of birth
Date of admission, date of separation (discharge) and length of hospital stay (in
days)
Separation type (patient destination on discharge from hospital): separation and
transfer to acute hospital /extended care, death, separation to private
residence,/accommodation, separation and transfer to aged care residential facility,
separation and transfer to mental health residential facility etc.
1.1.2 Injury surveillance items
Up to 40 ICD-10-AM codes from any or all of the chapters of the ICD-10-AM manual can currently
be assigned to each record. These codes are then used to derive the following injury surveillance
variables that are added to the VISU-VAED dataset.
 Cause of injury – transport, fall, poisoning etc.
[Coded to ICD-10-AM Chapter XX: External Causes of Morbidity and Mortality (V00-Y34)]
 Place of occurrence i.e. location of injury - home, road, street or highway etc. [Coded to
ICD-10-AM Chapter XX: External Causes of Morbidity and Mortality (Y92.0-Y92.9)]
 Activity when injured - sports, leisure, work etc.
[Coded to ICD-10-AM Chapter XX: External Causes of Morbidity and Mortality (U50-U73)]
 Human intent – unintentional; intentional-assault, neglect, self-harm; undetermined intent.
Intent information is derived from the external cause of injury code.
 Injury diagnosis i.e. exact injury code – superficial injury of scalp, fracture of neck of femur
etc. (Coded to ICD-10-AM Chapter 19 Injury, Poisoning and Consequences of External
Cause S00-T98)
42
Appendix 2



E-bulletin 13 – VISU April 2016
Body region injured – head, thorax, shoulder, upper arm etc. Body region information is
derived from the injury diagnosis variables.
Nature of main injury - open wound, fracture, dislocation/sprain/strain etc. Nature of main
injury is derived from the injury diagnosis variables.
Comorbidities – co-occurrence of injury with other diseases and conditions that can happen
by chance or because there is some association between them (for example, suicide and
mental disorders, drowning or hot water scalds and epilepsy). Co-morbidities are derived
from the diagnosis variables (Coded to ICD-10-AM Chapters 1-17).
1.2 Case selection (for this report):





Victorian hospital admissions recorded on the VAED occurring 1 July 2014 to 30 June 2015,
coded according to the 8th edition of ICD-10–AM (NCCH, July 2013).
Cases with an external cause of morbidity in ICD-10-AM range V00-X59 (i.e. unintentional
section of Chapter XX External causes of morbidity and mortality).
Cases with a community injury (in ICD 10 AM range S00-T75 or T79) in the first diagnosis
code (see Box 2).
Mode of admission has any value except those indicating that transfer from another hospital
has occurred or that the record is a ‘statistical separation’- a change of care type within a
hospital. The aim of these omissions is to reduce over-counting of cases and to provide an
estimated incidence of admission.
VAED cases recorded as not having spent the entire episode in the ED (see Box 2).
Case selection for bed-days
Each record in the VAED refers to a single episode of care in a hospital and some injuries result
in more than one episode in hospital and therefore more than one VAED record. The VAED
does not include information designed to enable the set of records belonging to an injury case to
be recognised as such. Hence, there is potential for some incident injury cases to be counted
more than once. Therefore for incident estimates, transfers within and between hospitals, as
well as rehabilitation cases, were excluded. The episodes omitted to reduce overestimation of
incident cases were, however, included when providing estimates of bed-days.

Cases with a principal diagnosis as an injury in the ICD-10-AM code range S00-T75.9, T79T79.9, T89-T98.99 (these codes exclude medical injury) or was one of two relevant
rehabilitation codes - Z094 (follow-up examination after treatment of a fracture) or Z509
(care involving use of rehabilitation procedure, unspecified). Z509 cases were only included
if one of the above injury diagnosis codes was also coded in the patient’s hospital record.
Box 2: Community injury
Most injuries occur in settings such as car crashes, inter-personal violence, sporting and recreational activities,
and work and these can be referred to as ‘community injury’ (AIHW 2012). Community injuries are the main
subject of this report so cases selected are specific to those with a community injury in the principal diagnosis
code (i.e., ICD-10-AM codes S00-T75 and T79). Other injuries occur in the context of surgical and medical care,
where they are often referred to as complications – these are not included in this report.
Box 3: Change to Victorian hospital admission policy
In July 2012 the Victorian Hospital Admission Policy changed significantly so that episodes of care delivered
entirely within a designated emergency department or urgent care centre could no longer be categorised as an
admission regardless of the amount of time spent in the hospital. Previously, these types of episodes could be
categorised as an admission if the length of time in the hospital was four hours or more. This has had the effect of
reducing the number of admissions recorded on the VAED post 2012/13 financial year.
In order to minimise the influence of the hospital admission policy change on trends in the admissions data, VAED
cases recorded as spending the entire episode in the ED have been removed from the entire time period.
43
E-bulletin 13 – VISU April 2016
Appendix 2
2. Emergency Department Presentations
2.1 Source: Victorian Emergency Minimum Dataset (VEMD)
The Victorian Injury Surveillance System began in the Royal Children’s Hospital in 1988. It
expanded to adult hospitals over time with a large boost in 1995 when the Department of Human
Services absorbed the injury surveillance minimum dataset into the Victorian Emergency Minimum
Dataset (VEMD) that collects demographic, administrative and clinical data from public hospitals.
From January 2004, VEMD data are collected by all 38 Victorian public hospitals that provide a 24hour ED service. In July 2011 Bass Coast Regional Health began contributing to the VEMD taking
the total contributing hospitals to 39.
Emergency Department presentations for injury are extracted from the VEMD by the Victorian
DHHS and are now supplied annually in unit record format to VISU. Data for this edition of the Ebulletin were coded to the Victorian Emergency Minimum Dataset (VEMD) User Manual 19th
Edition, published by the DHHS. Prior to the hospital admission policy change in 2012/13 the VEMD
contained cases that were treated and discharged from the ED within 4 hours from the time patient
management commences (i.e. ‘non-admissions’) and cases that were defined as ‘admissions’
according to the Victorian hospital admission policy at the time (cases physically transferred to
another unit in the same hospital and those treated entirely within the ED for longer than 4 hours).
Post 2012/13 cases that were treated entirely within the ED for longer than 4 hours were not
considered as admissions (see Box 3).
When the data file is received by VISU, it is cleaned, checked and merged with the VISU-VEMD
injury surveillance dataset.
The VEMD data items held by VISU include:
2.1.1
Demographic/administrative items





Age, sex, postcode, suburb and local government area of residence
Country of birth, preferred language spoken at home
Time and date of presentation to ED
Departure status (patient destination on discharge from ED i.e. admitted to ward, died
within ED, discharged home, discharged to residential care etc.)
Referred to on departure (outpatients, local medical officer i.e. GP, home nursing
service, scheduled review in ED etc.)
2.1.2 Injury surveillance items







Human intent (unintentional, assault, self-harm etc.)
Cause of injury (fall, poisoning etc.)
Place where injury occurred i.e. location of injury (home, road, street or highway etc.)
Activity when injured (sports, leisure, work etc.)
Nature of main injury
Body region injured
Description of injury event (‘narrative’)
2.2 Case selection (for this report)



Victorian hospital ED presentations recorded on the VEMD occurring 1 July 2014 to 30 June
2015 coded according to the Victorian Emergency Minimum Dataset (VEMD) User Manual
19th edition.
Cases coded as unintentional injury (VEMD human intent=1).
Incident cases (excludes return visits and pre-arranged visits).
44